Provider Demographics
NPI:1902137375
Name:LAMAR, BLAKELEY GRANT (DC)
Entity Type:Individual
Prefix:
First Name:BLAKELEY
Middle Name:GRANT
Last Name:LAMAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 SCHERM RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-5300
Mailing Address - Country:US
Mailing Address - Phone:270-316-6347
Mailing Address - Fax:
Practice Address - Street 1:1605 SCHERM RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5300
Practice Address - Country:US
Practice Address - Phone:270-316-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor